Medicaid expansion was an important issue in the 2018 midterm elections. Three states – Idaho, Nebraska, and Utah – successfully passed ballot initiatives to expand their Medicaid programs, while Kansas and Maine elected pro-expansion governors. As a result, almost 500,000 additional low-income citizens will be eligible to enroll in the government-run health program. Here is a summary of the recent expansion activity.



Since voters in Idaho supported Idaho Proposition 2, Governor-elect Brad Little (R) will implement the initiative. The state is now required to submit an amendment plan to CMS that will implement the expansion within 90 days of the approval. Additionally, the Idaho Department of Health and Welfare is authorized to take any actions necessary to put the provisions into effect.


Despite Governor Pete Rickett’s (R) opposition to Medicaid expansion, Nebraska Initiative 427 passed. The state will be required to submit a state plan amendment or documentation for waiver approval on or before April 1, 2019 to CMS. Furthermore, the Department of Human Services is responsible for taking “all actions necessary to maximize federal financial participation in funding medical assistance pursuant to this section.”


Utah Proposition 3 was voted in favor of and it calls for Utah to expand Medicaid by way of the ACA starting April 1, 2019. The initiative also prohibits future changes to the program or CHIP that could reduce coverage, benefits, or payment rates below policies from January 1, 2017. In order to finance the program expansion, the proposition will also increase the state’s sales tax by 0.15%.


While Kansas and Maine did not expand their programs with ballot initiatives, they are pursuing it with support from newly elected pro-expansion governors.


In 2017, the Kansas legislature passed a bill that would have expanded Medicaid. However, the governor at the time, Sam Brownback (R), vetoed it. Now, with Governor-elect Laura Kelly (D) assuming office, Medicaid expansion could very well materialize. Kelly has been a supporter of expansion and even ran on it.


Last year, Maine also passed a ballot initiative to expand Medicaid but the then governor, Paul LePage (R) refused to carry out the legislation. In fact, LePage even stated that he would go to jail before putting the ballot initiative into action. Regardless of his resistance, voters elected Janet Mills (D) on Tuesday. The governor-elect ran on Medicaid expansion and is committed to implementing the 2017 initiative as soon as she takes office.

Based on the Midterm results, Medicaid expansion has bipartisan appeal. Voters from both parties favor better access to care and improved outcomes for low-income Americans.

Health economists have been watching the program’s progress and are optimistic about the impact expansion will have. Benjamin Sommers studies Medicaid expansion at Harvard and says, “In terms of what happens to patients, we have 40-plus studies looking at this over the past decade. It makes a major difference in patients’ ability to access health care, to pay their bills, and in many studies, we see improved health outcomes too.” 

According to studies, populations in states that expand the program have better access to a larger range of health services. Patients also report that by having coverage, they incur less debt and are more capable of paying their medical bills. Other research found that states who expand Medicaid see a larger decline in infant mortality compared to states that do not participate in the program.

The findings from these studies highlight the benefits of Medicaid expansion. After the recent elections, a handful of states move closer to expanding coverage and making a difference in almost half a million lives.